Mallet FInger Injury

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​Background:

• Usually caused by a traumatic impaction blow (i.e. sudden forced flexion) to the tip of the finger in the extended position. Often seen in ball sport like basketball, volleyball, and baseball. Commonly, I’ve seen this mostly in basketball players who present after “jamming” their finger when going for a rebound. Essentially, this blow forces the DIP joint into forced flexion, which the DIP doesn’t like. So in response, you get a rupture of extensor tendon in area of distal phalanx distal to DIP joint

 
PE:

• DIP joint flexed to ~45°, lack of active DIP extension

 
Dx:

• Clinical diagnosis
• Consider finger x-ray (PA and lateral) to evaluate for avulsion fracture
• Now I’m sure you all know about Doyle’s classification of mallet finger injuries? Uh, yeah, of course. Yeah, me either. Let’s leave that to the hand surgeons. 

 
Tx:

• Now, most importantly… If left untreated, a mallet finger can lead to a swan neck deformity (PIP extension with DIP flexion; FDP unopposed)
• For ED treatment, Splint DIP joint in continuous slight hyperextension, but don’t overextend x 6-8 weeks
• Splinting of the PIP joint is not necessary and should be avoided; Let that PIP flow free!
  • Inadvertently splinting PIP for 6 weeks results in collateral ligamentous overgrowth and functional disability
• Discharge with hand surgery follow-up in 7-10 days

 
 
Aluminum and Foam strips
Advantages:

• Light weight and readily available

Disadvantages:

• Must be taped in place
• Patient cannot readily wash their hands while wearing
• The foam will degrade over time
• Skin can get macerated from lack of air getting to the skin

• Splint limits finger use

 
Stax Splint
Advantages:

• Lightweight and holds the fingertip straight

 Disadvantages:

• Must be taped on
• Covers the fingertip so patient’s finger cannot be used
• Difficult to wash hands while wearing
• Skin gets macerated

• Can be difficult to fit

 
Oval-8® Finger Splint
Advantages:

• One or two Oval-8 Finger Splints may be used to hold the DIP joint in extension while still allowing flexion of the proximal interphalangeal (PIP) joint
• Lightweight-- the fingertip is open for function
• Open design eliminates skin maceration
• Size adjustability designed into the Oval-8 accommodates changes in swelling
• Patient can wash hands easily by removing the splint

• Easy to slide on and off for skin care

Disadvantages:

• Professional adjustments may be needed for a custom fit

• May fall off if weather is cold or swelling decreases